[Hiring] Prior Authorization Specialist @SCHOOLCRAFT MEMORIAL HOSPITAL

Role Description

Responsible for initiating and obtaining prior authorizations for procedures and medications, scheduling appointments for outpatient services; coordinates patient appointments/orders. This position primarily works remotely.

Qualifications

• High school diploma or GED.
• Business healthcare degree or 2 years’ experience working in a medical office or insurance company.
• Heartsaver CPR Certified (obtain upon employment).

Requirements

• Ability to maintain effective working relationships with coworkers, patients, medical staff, insurance companies, and the public.
• Ability to take charge while remaining approachable, respectful, and understanding.
• Ability to communicate clearly and effectively in person, writing, or by phone.
• Ability to adapt to change.
• Ability to organize and prioritize tasks.
• Ability to operate computers, telephones, and other office equipment.
• Ability to react calmly and competently in emergency situations.
• Knowledge and understanding of insurance policies and benefits.
• Knowledge of medical terminology.
• Knowledge and understanding of insurance claim processing.
• Strong organizational skills.

Benefits

• Conduct Pre-authorizations with insurance companies for a multitude of different services.
• Discuss with patients necessary regulations in regard to Medicare billing and other non-covered procedures.
• Promote and maintain confidentiality.
• Inform supervisor of potential issues with insurance or patients.
• Coordinate and follow the established preauthorization review process for outpatient and inpatient services.
• Timely review of prior authorization requests, both inpatient and outpatient.
• Surgical/Diagnostic procedures/Therapies/DME/Infusions.
• Medication prior authorization requests.
• Other Prior Authorizations as the needs arise.
• Perform telephonic or electronic review of prior authorization requests for appropriate care setting, following guidelines and policies, and forward requests to appropriate departments.
• Complete medical necessity and level of care reviews for requested services using clinical judgment. Refer to medical staff for other determinations as needed.
• Provide clinical knowledge and act as clinical resource to non-clinical team.
• Schedule patient appointments in a timely manner once prior authorization has been approved. This includes contacting the patient with the appointment information and ensuring the patient receives the appropriate education for the scheduled event.
• Provides accurate documentation in patient EMR and reporting to other agencies (i.e., health department).
• Maintains accountability of patient records.
• Demonstrates appropriateness in meeting objectives in age-specifics.
• Performs other duties as assigned.